Staff training to implement dietary improvements to reduce fracture risk in aged care residents

The new Aged Care Act and Food and Nutrition Standards focus on nutritional needs of residents however, protein and calcium intakes in older adults in aged care remain below recommended levels. Improving protein and calcium intake in residents to recommended levels is associated with reduced falls, fractures, weight loss and malnutrition, with falls and weight loss being performance indicators in aged care. This intervention was undertaken through food service over 2-years with compliance maintained for the entire period indicating a feasible means to reduce adverse health outcomes in residents. To upscale benefits of this dietary improvement, we developed a training program to up skill food service staff to deliver foods in line with intervention. We aimed to determine if food service staff training results in increased protein and calcium intakes in residents. This 12-week cluster randomised trial involved 12 aged care homes; 6 randomised to intervention (staff training) and 6 to control (residents consume from regular menus). Residents consented to food intake (plate waste analysis), nutritional status (mini nutrition assessment tool) and quality of life (EQ-5D-5L) assessments at baseline and week 12 with medical records reviewed at baseline. Staff were interviewed before and after training and intervention to determine barriers to implementation. Analysis of dietary outcomes was performed using a linear mixed effects model, with home entered as a random intercept, and baseline values entered as covariates. Data was obtained from 78 residents (median age 84.5 years; IQR: 80–89, 85% female, n = 52 intervention). Baseline protein (65 g/day; IQR 53–78, 0.9 g/kg body weight; IQR:0.7–1.1) and calcium (773 mg/day; IQR: 605–982) intakes were below the respective recommended levels of 1 g/kg body weight and 1100 mg/day. Following intervention group differences were observed for daily intakes of protein (16 g/day; 95%CI: −3, 35), calcium (302 mg/day; 95%CI: 117, 486) and dairy servings (0.9 s/day; 95%CI: 0.3, 1.5). Staff provided insights into implementation barriers. Improvements to protein and calcium intakes in residents were observed, that are associated with reduced adverse clinical outcomes. However, operational constraints may impeded intervention efficacy and detection of anti-fracture efficacy limited by the short study duration. A potential solution is mandating food standards in aged care to ensure nutritional adequacy in residents to reduce adverse clinical outcomes such as falls and fractures.